Monday, April 09, 2012

Effects of EHRs Differ Between Provider Populations

Physicians order fewer lab tests when they have access to a patient's electronic health records (EHR), but the efficiency may be confined to state-of-the-art records exchanges for now, says a Reuters Healtharticle based on a study published March 26 in Archives of Internal Medicine.

The study is on the experience of 2 hospitals-Brigham and Women's and Massachusetts General-that form Partners HealthCare, a nonprofit health care system in Boston. In the year 2000, the 2 hospitals established a health information exchange to access each others' EHRs.

The researchers examined EHRs of 117,606 people who were outpatients at 1 of the hospitals between January 1, 1999, and December 31, 2004. Of those, 346 had recent tests done at the other hospital-44 patients had them done before the information exchange was rolled out. As for those who did not have recent test results available, 21,968 were at 1 of the hospitals before the exchange.

Study author Alexander Turchin, MD, MS, told Reuters Health that the number of lab tests ordered for each patient before the exchange in 1999 was about 7. That number fell to about 4 in 2004. For patients without prior tests, the amount slightly increased to roughly 6 tests per patient from about 5.

Compared to the slight increase for patients without tests, the number of tests ordered for those with previous results decreased 49% after the exchange was established. After adjusting for age, sex, the year, and number of the tests, the number of tests ordered decreased about 53%.

The findings, however, contradict those of an article published last month in Health Affairs that suggest that office-based physicians with electronic access to imaging and lab results order more tests.

"We studied a different population," said Danny McCormick, the author of the Health Affairs study. The question is the same, the population is very different."

McCormick said that the Partners HealthCare study is "consistent with other past research and looks at the Partners' exchange system-which he called cutting-edge-whereas his study looked at what is currently happening in physicians' offices across the US."

Although physical therapists (PTs) are not yet required or incentivized to adopt EHR systems for such initiatives as Medicare's Meaningful Use Program, physicians and facilities that are included in the program will expect PTs with whom they share patients to use compatible EHR systems. As such, APTA has developed a number of resources for members to assist in assessing and implementing electronic health records.